A New Method to Minimize the Standard Deviation and Root Mean Square of the Prediction Error of Single-Optimized IOL Power Formulas.

Purpose: The purpose of this study was to develop a simplified method to approximate constants minimizing the standard deviation (SD) and the root mean square (RMS) of the prediction error in single-optimized intraocular lens (IOL) power calculation formulas. Methods: The study introduces analytical formulas to determine the optimal constant value for minimizing SD and RMS in single-optimized IOL power calculation formulas. These formulas were tested against various datasets containing biometric measurements from cataractous populations and included 10,330 eyes and 4 different IOL models. The study evaluated the effectiveness of the proposed method by comparing the outcomes with those obtained using traditional reference methods. Results: In optimizing IOL constants, minor differences between reference and estimated A-constants were found, with the maximum deviation at -0.086 (SD, SRK/T, and Vivinex) and -0.003 (RMS, PEARL DGS, and Vivinex). The largest discrepancy for third-generation formulas was -0.027 mm (SD, Haigis, and Vivinex) and 0.002 mm (RMS, Hoffer Q, and PCB00/SN60WF). Maximum RMS differences were -0.021 and +0.021, both involving Hoffer Q. Post-minimization, the largest mean prediction error was 0.726 diopters (D; SD) and 0.043 D (RMS), with the highest SD and RMS after adjustments at 0.529 D and 0.875 D, respectively, indicating effective minimization strategies. Conclusions: The study simplifies the process of minimizing SD and RMS in single-optimized IOL power predictions, offering a valuable tool for clinicians. However, it also underscores the complexity of achieving balanced optimization and suggests the need for further research in this area. Translational Relevance: The study presents a novel, clinically practical approach for optimizing IOL power calculations.

Investigating the topographic effect of epithelium in myopic eyes with subtle topographic preoperative abnormalities.

PURPOSE: To explore the topographic impact of the epithelium in Keratoconus Suspected (KCS) and in "Normal" Placido classified corneas. SETTING: Rothschild Foundation, Paris, France. DESIGN: Prospective interventional case series. METHODS: Anterior corneal specular Placido topography using OPD-Scan® II (NIDEK, Gammagori, Japan) was performed in 97 eyes of 67 patients undergoing PRK for myopia, before and after epithelium removal. The differences in axial keratometry, asphericity and astigmatism were computed. RESULTS: After epithelial peeling, some Placido-normal classified corneas became KCS. Therefore, we have subdivided this group into two groups: one of normal classified corneas which stayed normal after epithelium removal (Group NN), and one of corneas that became KCS classified (Group NK).The mean difference in axial mean keratometry in the third central millimeter rings was +0.50 ± 0.24 D, 0.69 ± 0.31 D and 0.49 ± 0.35 D and the mean difference in the magnitude of epithelial induced astigmatism in the first central millimetre ring was 0.37 D x 89° (positive cylinder), 0.54 D 86° and 0.52 D 86° respectively in Group NN, NK and KK (KCS corneas that stayed KCS). These differences were significant (p< 0.0001). Preoperative keratometry was the only predictive factor differentiating Group NN from NK (p<0.001). CONCLUSIONS: The epithelial layer tended to reduce the magnitude of the Bowman layer's astigmatism, prolateness and keratometry, more importantly in Group NK. In KK group we found a similar trend as in normal eyes (Group NN). The epithelium would be able to mask Bowman layer's irregularities until a certain degree of severity.

High hyperopic LASIK with reduction of corneal prolateness to control induced spherical aberration.

PURPOSE: To evaluate visual outcomes of high hyperopic LASIK, using corneal aspherization to control the induced spherical aberration. SETTING: Fondation Ophtalmologique Adolphe de Rothschild. DESIGN: Prospective interventional case series. METHODS: Prospective interventional study of consecutive high hyperopes (≥+3D of Spherical Equivalent SE) undergoing LASIK with the WaveLight FS200 femtosecond and EX500 excimer laser platform. An aspheric ablation profile (planned change in corneal asphericity ΔQ = +0.2) was delivered using the Custom-Q nomogram (Alcon Laboratories, Inc., Fort Worth, TX) on an optical zone of ≥ 6.5mm centered near the corneal vertex. Uncorrected and best-corrected distance visual acuity (UDVA-BDVA), as well as changes in SE, corneal asphericity (ΔQ) and Higher order aberrations (HOAs), were analyzed preoperatively and on day1, 1, 3, 6, and 12 months. RESULTS: 117 eyes of 63 patients, (mean age of 30.1 ± 5.6 years), were included. Preoperatively and at 12 months postoperatively, the mean SE was 5.1 ± 1.1 D and 0.00 ± 0.7 D, respectively. 88% of eyes achieved 0 Log Mar or better UDVA at 12 months. One month after surgery, there was a statistically significant induction of positive spherical aberration decreasing progressively and significantly until the last visit (Preop SA4 = 0.09 ± 0.11 µm, Day 1 SA4 = 0.30 ± 0.32 µm, 12 Months SA4 = 0.08 ± 0.21 µm, p=0.056). Two eyes needed enhancement at 12 months. CONCLUSION: LASIK for high levels of hyperopia showed good outcomes mainly due to aspheric-customized ablation profile with a change of ΔQ = +0.2 in corneal asphericity.

Performance of a simplified strategy for formula constant optimisation in intraocular lens power calculation.

PURPOSE: To investigate the performance of a simple prediction scheme for the formula constants optimised for a mean refractive prediction error. METHODS: Analysis based on a dataset of 888 eyes before and after cataract surgery with IOL implantation (Hoya Vivinex). IOLMaster 700 biometric data, power of the implanted lens and postoperative spherical equivalent refraction were used to calculate the optimised constants (.)opt for SRKT, HofferQ, Holladay and Haigis formula with an iterative nonlinear optimisation. For detuning start values by ±1.5 from (.)opt, the predicted formula constants (.)pred were calculated and compared with (.)opt. Formula performance metrics mean (MPE), median (MEDPE), mean absolute (MAPE), median absolute (MEDAPE), root mean squared (RMSPE) and standard deviation (SDPE) of the formula prediction error were analysed for (.)opt and (.)pred. RESULTS: (.)pred - (.)opt showed a 2nd order parabolic behaviour with maximal deviations up to 0.09 at the tails of detuning and a minimal deviation up to -0.01 for all formulae. The performance curves of different metrics of PE as functions of detuning variations show that the formula constants for zeroing MPE and MEDPE yield almost identical formula constants, optimisation for MAPE, MEDAPE and RMSPE yielded formula constants very close to (.)opt, and optimisation for SDPE could result in formula constants up to 0.5 off (.)opt which is unacceptable for clinical use. CONCLUSION: This simple prediction scheme for formula constant optimisation for zero mean refraction error performs excellently in our monocentric dataset, even for larger deviations of the start value from (.)opt. Further studies with multicentric data and larger sample sizes are required to investigate the performance in a clinical setting further.

Leaving trusted paths: Estimating corneal keratometric index in cataract surgery eyes with zero-power implants.

PURPOSE: This study aimed to estimate the corneal keratometric index in the eyes of cataract surgery patients who received zero-power intraocular lenses (IOLs). METHODOLOGY: This retrospective study analyzed postoperative equivalent spherical refraction and axial length, mean anterior curvature radius and aqueous humor refractive index to calculate the theoretical corneal keratometric index value (nk). Data was collected from 2 centers located in France and Germany. RESULTS: Thirty-six eyes were analyzed. The results revealed a mean corneal keratometric index of 1.329 ± 0.005 for traditional axial length (AL) and 1.331 ± 0.005 for Cooke modified axial length (CMAL). Results ranged from minimum values of 1.318/1.320 to maximum values of 1.340/1.340. CONCLUSION: The corneal keratometric index is a crucial parameter for ophthalmic procedures and calculations, particularly for IOL power calculation. Notably, the estimated corneal keratometric index value of 1.329/1.331 in this study is lower than the commonly used 1.3375 index. These findings align with recent research demonstrating that the theoretical corneal keratometric index should be approximately 1.329 using traditional AL and 1.331 using CMAL, based on the ratio between the mean anterior and posterior corneal curvature radii (1.22).

Current concepts in the management of cataract with keratoconus.

This review analyzed all pertinent articles on keratoconus (KCN) and cataract surgery. It covers preoperative planning, intraoperative considerations, and postoperative management, with the aim of providing a simplified overview of treating such patients. Preoperatively, the use of corneal cross-linking, intrastromal corneal ring segments, and topo-guided corneal treatments can help stabilize the cornea and improve the accuracy of biometric measurements. It is important to consider the advantages and disadvantages of traditional techniques such as penetrating keratoplasty and deep anterior lamellar keratoplasty, as well as newer stromal augmentation techniques, to choose the most appropriate surgical approach. Obtaining reliable measurements can be difficult, especially in the advanced stages of the disease. The choice between toric and monofocal intraocular lenses (IOLs) should be carefully evaluated. Monofocal IOLs are a better choice in patients with advanced disease, and toric lenses can be used in mild and stable KCN. Intraoperatively, the use of a rigid gas permeable (RGP) lens can overcome the challenge of image distortion and loss of visual perspective. Postoperatively, patients may need updated RGP or scleral lenses to correct the corneal irregular astigmatism. A thorough preoperative planning is crucial for good surgical outcomes, and patients need to be informed regarding potential postoperative surprises. In conclusion, managing cataracts in KCN patients presents a range of challenges, and a comprehensive approach is essential to achieve favorable surgical outcomes.

Intra-Observer and Inter-Observer Variability of Intraocular Lens Measurements Using an Interferometry Metrology Device.

The NIMO TEMPO (Lambda-X, Nivelles, Belgium) is a novel, user-friendly and compact device designed for in vitro optical analysis of refractive and diffractive intraocular lenses (IOLs). This device analyzes the IOL wavefront and generates a synthetic eye model for numerical computation. The objective of this study was to evaluate the precision of this innovative device. Intra- and inter-observer variability were calculated using a two-way analysis of variance (ANOVA) after conducting ten measurements of eight different IOL models, with each measurement being repeated by three distinct operators (resulting in a total of 30 measurements for each IOL). The device demonstrated satisfactory intra- and inter-observer variability in evaluating IOL power and modulation transfer function (MTF) profiles, with values of 0.066 and 0.078 diopters for IOL power and 0.018 and 0.019 for MTF measurements, respectively. Furthermore, this hybrid optical and numerical in vitro IOL wavefront analyzer appears to have several advantages over conventional optical bench devices. It reduces the need for operator manipulation, and allows for numerical modeling of various optical environments, including cornea models and apertures. In conclusion, this novel metrology device designed for refractive and diffractive IOLs appears to provide a satisfactory precision, making it a promising tool in the field of IOL metrology.

Technique of corneal allogenic ring segment preparation using femtosecond laser: preclinical study on human corneal grafts.

PURPOSE: To describe a new technique for preparing corneal allogenic ring segments (CAIRSs) using femtosecond laser technology. SETTING: Hospital Foundation Adolphe de Rothschild-Noémie de Rothschild institute, Paris, France. DESIGN: Preclinical study conducted on human corneal grafts. METHODS: The corneal grafts were mounted on an artificial chamber pressurizer (ACP) with preset constant pressure, and the FSL was used to create a circular annulus with specific dimensions. The resulting CAIRSs were analyzed for their thickness and width after air drying. RESULTS: A total of 25 CAIRSs were prepared using the FSL. The mean width and thickness of the CAIRSs were 803 ± 77 µm and 83 ± 16 µm, respectively. Statistical analysis revealed no significant differences in width among the various quadrants of each CAIRS or between different CAIRSs. Significantly thicker CAIRSs were obtained with a higher ACP pressure. CONCLUSIONS: The technique of CAIRS preparation using FSL technology and controlled artificial anterior chamber pressure demonstrated reproducibility and precision. This approach holds the potential for customizing and personalizing CAIRSs based on individual corneal characteristics.

Differences Between Keratometry and Total Keratometry Measurements in a Large Dataset Obtained With a Modern Swept Source Optical Coherence Tomography Biometer.

PURPOSE: This study aimed to explore the concept of total keratometry (TK) by analyzing extensive international datasets representing diverse ethnic backgrounds. The primary objective was to quantify the disparities between traditional keratometry (K) and TK values in normal eyes and assess their impact on intraocular lens (IOL) power calculations using various formulas. DESIGN: Retrospective multicenter intra-instrument reliability analysis. METHODS: The study involved the analysis of biometry data collected from ten international centers across Europe, the United States, and Asia. Corneal power was expressed as equivalent power and astigmatic vector components for both K and TK values. The study assessed the influence of these differences on IOL power calculations using different formulas. The results were analyzed and plotted using Bland-Altman and double angle plots. RESULTS: The study encompassed a total of 116,982 measurements from 57,862 right eyes and 59,120 left eyes. The analysis revealed a high level of agreement between K and TK values, with 93.98% of eyes exhibiting an absolute difference of 0.25 D or less. Astigmatism vector differences exceeding 0.25 D and 0.50 D were observed in 39.43% and 1.08% of eyes, respectively. CONCLUSIONS: This large-scale study underscores the similarity between mean K and TK values in healthy eyes, with rare clinical implications for IOL power calculation. Noteworthy differences were observed in astigmatism values between K and TK. Future investigations should delve into the practicality of TK values for astigmatism correction and their implications for surgical outcomes.

Cataract surgery after corneal refractive surgery: preoperative considerations and management.

PURPOSE OF REVIEW: Corneal refractive surgery (CRS) is one of the most popular eye procedures, with more than 40 million cases performed globally. As CRS-treated patients age and develop cataract, the number of cases that require additional preoperative considerations and management will increase around the world. Thus, we provide an up-to-date, concise overview of the considerations and outcomes of cataract surgery in eyes with previous CRS, including surface ablation, laser in-situ keratomileusis (LASIK), and small-incision lenticule extraction (SMILE). RECENT FINDINGS: Challenges associated with accurate biometry in eyes with CRS have been mitigated recently through total keratometry, ray tracing, intraoperative aberrometry, and machine learning assisted intraocular lens (IOL) power calculation formulas to improve prediction. Emerging studies have highlighted the superior performance of ray tracing and/or total keratometry-based formulas for IOL power calculation in eyes with previous SMILE. Dry eye remains a common side effect after cataract surgery, especially in eyes with CRS, though the risk appears to be lower after SMILE than LASIK (in the short-term). Recent presbyopia-correcting IOL designs such as extended depth of focus (EDOF) IOLs may be suitable in carefully selected eyes with previous CRS. SUMMARY: Ophthalmologists will increasingly face challenges associated with the surgical management of cataract in patients with prior CRS. Careful preoperative assessment of the ocular surface, appropriate use of IOL power calculation formulas, and strategies for presbyopia correction are key to achieve good clinical and refractive outcomes and patient satisfaction. Recent advances in CRS techniques, such as SMILE, may pose new challenges for such eyes in the future.

Paper waste from instructions for use brochures in cataract surgery implant packaging in Europe and the United States.

PURPOSE: To assess the extent of paper waste generated per year by instructions for use (IFUs) brochures included in intraocular lens (IOL) packaging in Europe and the U.S. SETTING: Rothschild Foundation Hospital, Paris, France; Royal Free London NHS Foundation Trust; Center for Sight, London, United Kingdom. DESIGN: Experimental study. METHODS: A sample of IOLs were collected and each IFU was weighed. In addition, the cumulative weight of these brochures used in cataract surgeries performed annually in Europe and the U.S. was estimated, and the potential annual paper conservation that could be achieved if all manufacturers adopted electronic IFUs (e-IFUs) in Europe and the U.S. was determined. RESULTS: The mean and standard deviation of the weight for overall IFUs, classic IFUs, and e-IFUs were 17.6 ± 13.8 g, 23.5 ± 13.2 g, and 2.9 ± 1.9 g, respectively. The estimated cumulative weight of paper generated from the IFUs accompanying implants used in European and U.S. cataract surgeries is 153 tons. If all manufacturers transition to e-IFUs, the cumulative weight saved would be 128 tons (-84%), equivalent to 120 tons of carbon dioxide equivalent and the preservation of more than 2000 trees annually. CONCLUSIONS: The classic IFUs in IOL packaging result in a significant amount of paper waste annually. Therefore, there is an urgent need for a rapid transition to e-IFU technology. The adoption of e-IFUs has already been authorized in Europe and the U.S., and it is crucial to expedite this process.

Monte-Carlo simulation of a thick lens IOL power calculation.

BACKGROUND: The purpose of this Monte-Carlo study is to investigate the effect of using a thick lens model instead of a thin lens model for the intraocular lens (IOL) on the resulting refraction at the spectacle plane and on the ocular magnification based on a large clinical data set. METHODS: A pseudophakic model eye with a thin spectacle correction, a thick cornea (curvatures for both surfaces and central thickness) and a thick IOL (equivalent power PL derived from a thin lens IOL, Coddington factor CL (uniformly distributed from -1.0 to 1.0), either preset central thickness LT = 0.9 mm (A) or optic edge thickness ET = 0.2 mm, (B)) was set up. Calculations were performed on a clinical data set containing 21 108 biometric measurements of a cataractous population based on linear Gaussian optics to derive spectacle refraction and ocular magnification using the thin and thick lens IOL models. RESULTS: A prediction model (restricted to linear terms without interactions) was derived based on the relevant parameters identified with a stepwise linear regression approach to provide a simple method for estimating the change in spectacle refraction and ocular magnification where a thick lens IOL is used instead of a thin lens IOL. The change in spectacle refraction using a thick lens IOL with (A) or (B) instead of a thin lens IOL with identical power was within limits of around ±1.5 dpt when the thick lens IOL was placed with its haptic plane at the plane of the thin lens IOL. In contrast, the change in ocular magnification from considering the IOL as a thick lens instead of a thin lens was small and not clinically significant. CONCLUSION: This Monte-Carlo simulation shows the impact of using a thick lens model IOL with preset LT or ET on the resulting spherical equivalent refraction and ocular magnification. If IOL manufacturers would provide all relevant data on IOL design data and refractive index for all power steps, this would make it possible to perform direct calculations of refraction and ocular magnification.

Angle Kappa Influence on Multifocal IOL Outcomes.

PURPOSE: To characterize angle kappa and study the relationship between preoperative angle kappa and postoperative refractive accuracy, visual outcomes, and patient satisfaction in a large population of eyes with multifocal intraocular lens (MIOL) implantation. METHODS: A comprehensive electronic medical record chart review of 26,470 consecutive eyes that underwent immediate sequential bilateral cataract or refractive lens exchange with MIOLs was conducted. The primary outcome measures were postoperative monocular uncorrected distance visual acuity (UDVA), manifest refraction sphere and cylinder, spherical equivalent (SEQ), defocus equivalent (DEQ), subjective quality of vision at near, intermediate, and distance, and the likelihood of recommending the procedure. Relationships between preoperative angle kappa and postoperative outcomes were assessed with Pearson correlations. RESULTS: Angle kappa followed a right-skewed normal distribution (R2 = 0.99) with a mean ± standard deviation of 0.64 ± 0.27 mm. No clinically meaningful relationship was found between preoperative angle kappa and postoperative sphere, cylinder, SEQ, and DEQ, all with R2 ⩽ 0.0005. Similarly, there was no clinically meaningful relationship between preoperative angle kappa and postoperative UDVA (R2 = 0.001), postoperative satisfaction for near, intermediate, and distance vision (all R2 ⩽ 0.0023), or for recommending the MIOL surgery to friends and relatives (R2 = 0.0000). CONCLUSIONS: Preoperative angle kappa does not have a predictive clinical impact on postoperative MIOL visual outcomes, refractive accuracy, or subjective patient satisfaction. Angle kappa as a single variable cannot be used to determine MIOL candidacy. [J Refract Surg. 2023;39(12):840-849.].

Long-Term Follow-Up of Descemet Stripping Only: Data Up to 7 Years Postoperatively.

PURPOSE: The aim of this study was to report long-term follow-up of eyes undergoing Descemet stripping only (DSO). METHODS: This was a retrospective study including 26 eyes of 20 patients undergoing DSO between December 2015 and November 2022. Eligibility criteria included peripheral endothelial cell count (ECC) >1000 cells/mm2 and symptoms caused by central guttata. Patients underwent a central circular 4-mm descemetorhexis using a reverse Sinskey hook and a pair of descemetorhexis forceps using a peeling technique. Three parameters were measured before surgery and at last follow-up: best-corrected visual acuity (BCVA), central corneal thickness (CCT), and ECC measured centrally and at the periphery. RESULTS: The mean age was 73 ± 9 years [52-90 years]. The average follow-up period was 23.7 ± 24.8 months [3-84]. Twenty-two eyes responded to DSO with 20 female eyes (91%) and 2 male eyes (9%). The mean postoperative BCVA improved from 0.3 ± 0.17 logMAR to 0.09 ± 0.13 logMAR (P value <0.05). The mean postoperative CCT decreased from 588 ± 41 µm to 546 ± 50 µm (P-value <0.05). The mean postoperative central ECC was 780 ± 257 cells/mm2 [484-1500]. Peripheral ECC decreased postoperatively (1837 ± 407 cells/mm2 preoperatively to 864 ± 340 cells/mm2 postoperatively, P value >0.05). Peripheral endothelial cell polymegathism was stable (average of 26.8% ± 6.8% preoperatively and 30.2% ± 14% postoperatively). Average peripheral endothelial cells polymorphism decreased postoperatively (63.1 ± 20.5% preoperatively to 33% ± 25% postoperatively, P value >0.05). Four eyes did not show improvement after DSO and underwent Descemet membrane endothelial keratoplasty surgery. There were 3 men (75%) and 1 women (25%). The preoperative trend was for nonresponders to have lower BCVA, higher CCT, more abnormal peripheral polymorphism, and polymegathism. CONCLUSIONS: The results of this study, with up to 7 years follow up, demonstrate the durability of DSO.

Impact of Single Constant Optimization on the Precision of IOL Power Calculation.

Purpose: The primary objective of this research is to examine how precision in intraocular lens calculation formulas can be impacted by zeroing the mean error through adjustments in the effective lens position value. Additionally, the study aims to evaluate how this modification influences outcomes differently based on the source of the prediction error. Methods: In order to analyze the impact of individual variables on the standard deviation, the study maintained all variables constant except for one at a time. Subsequently, variations were introduced to specific parameters, such as corneal curvature radius, keratometric refractive index, axial length, and predicted implant position. Results: According to our findings, when zeroing the mean error is applied to correct for inaccuracies in corneal power estimation, it results in a significant and exponential rise in standard deviation, thus adversely affecting the formula's precision. However, when zeroing is employed to compensate for prediction errors stemming from axial length measurements or predicted implant position, the effect on precision is minimal or potentially beneficial. Conclusions: The study highlights the potential risks associated with the indiscriminate but necessary zeroing of prediction errors in implant power calculation formulas. The impact on formula precision greatly depends on the source of the error, underscoring the importance of error source when analyzing variations in the standard deviation of the prediction error after zeroing. Translational Relevance: Our study contributes to the ongoing effort to enhance the accuracy and reliability of these formulas, thereby improving the surgical outcomes for cataract patients.

The Development of a Thick-Lens Post-Myopic Laser Vision Correction Intraocular Lens Calculation Formula.

PURPOSE: To describe the development of the post-myopic laser vision correction (LVC) version of the PEARL-DGS intraocular lens (IOL) calculation formula and to evaluate its outcomes on an independent test set. DESIGN: Retrospective, single-center case series. METHODS: A modified lens position prediction algorithm was designed along with methods to predict the posterior corneal curvature radius and correct the corneal power measurement error. A different set of previously operated eyes that underwent LVC was used to evaluate the prediction precision of the post-LVC formula. RESULTS: Post-LVC PEARL-DGS formula significantly reduced mean absolute error of prediction in comparison to Haigis-L, Shammas, and American Society of Cataract and Refractive Surgery (ASCRS) average formulas (P < .001). It exhibited similar postoperative refractive precision as the Barrett True-K No History formula (P = .61). CONCLUSION: The post-LVC formula development process described in this article performed as well as the state-of-the-art post-LVC formula on the present test set. Further studies are required to assess its efficacy in other independent sets.

Novel deep learning approach to estimate rigid gas permeable contact lens base curve for keratoconus fitting.

INTRODUCTION: Rigid gas permeable contact lenses (RGP) are the most efficient means of providing optimal vision in keratoconus. RGP fitting can be challenging and time-consuming for ophthalmologists and patients. Deep learning predictive models could simplify this process. OBJECTIVE: To develop a deep learning model to predict the base curve (R0) of rigid gas permeable contact lenses for keratoconus patients. METHODS: We conducted a retrospective study at the Rothschild Foundation Hospital between June 2012 and April 2021. We included all keratoconus patients fitted with Menicon Rose K2® lenses. The data was divided into a training set to develop the model and a test set to evaluate the model's performance. We used a U-net architecture. The raw matrix of anterior axial curvature in millimeters was extracted from Scheimpflug examinations for each patient and used as input for the model. The mean absolute error (MAE) between the prediction and the prescribed R0 was calculated. Univariate and multivariate analyses were conducted to assess the model's errors. RESULTS: Three hundred fifty-eight eyes from 202 patients were included: 287 eyes were included in the training dataset, and 71 were included in the testing dataset. Our model's Pearson coefficient of determination (R2) was calculated at 0.83, compared to 0.75 for the manufacturer's recommendation (mean keratometry, Km). The mean square error of our model was calculated at 0.04, compared to 0.11 for Km. The predicted R0 MAE (0.16 ± 0.13) was statistically significantly different from the Km MAE (0.23 ± 0.23) (p = 0.02). In multivariate analysis, an apex center outside the central 5 mm region was the only factor significantly increasing the prediction absolute error. CONCLUSION: Our deep learning approach demonstrated superior precision in predicting rigid gas permeable contact lens base curves for keratoconus patients compared to the manufacturer's recommendation. This approach has the potential to be particularly beneficial in complex fitting cases and can help reduce the time spent by ophthalmologists and patients during the process.

Discrimination between keratoconus, forme fruste keratoconus, and normal eyes using a novel OCT-based tomographer.

PURPOSE: To combine objective machine-derived corneal parameters obtained with new swept-source optical coherence tomography (SS-OCT) tomographer (Anterion) to differentiate between normal (N), keratoconus (KC) and forme fruste KC (FFKC). SETTING: Laser Center, Hôpital Fondation Adolphe de Rothschild, Paris, France. DESIGN: Retrospective study. METHODS: 281 eyes of 281 patients were included and divided into 3 groups: N (n = 156), FFKC (n = 43), and KC (n = 82). Eyes were included in each group based on objective evaluation using Nidek Corneal Navigator, and subjective evaluation by authors. The SS-OCT system provided anterior and posterior corneal surface and pachymetry derived variables. The training set was composed of 143 eyes (95 N, 43 FFKC). Discriminant analysis was used to determine the group of an observation based on a set of variables. The obtained formula was tested in the validation set composed of 61 N and 82 KC. RESULTS: Among curvature parameters, the FFKC had significantly higher irregularity index at 3 mm and 5 mm, higher inferior-superior index, higher SteepK-OppositeK index and inferiorly decentered posterior steepest keratometry. Among thickness parameters: central pachymetry, thinnest pachymetry, percentage of thickness increase from center to periphery, and inferior decentration of the thinnest point were statistically different between groups. Combination of multiple variables into a discriminant function (F1) included 5 parameters and reached an area under the receiver operating characteristic curve (AUROC) of 0.95 (sensitivity = 75%, specificity = 98.5%) for detection of FFKC. F1 differentiates N from KC with AUROC = 0.99 (sensitivity = 99%, specificity = 99%). CONCLUSIONS: Combining anterior and posterior curvatures variables along with pachymetric data obtained from SS-OCT allowed automated detection of early KC and KC with very good accuracy (87% and 99.5% respectively).

Descemet Membrane Endothelial Keratoplasty with cornea press technique and implantation of a Carlevale scleral-fixated intraocular lens.

Purpose: We describe a combined Descemet Membrane Endothelial Keratoplasty (DMEK) using the Cornea-press (C-Press) technique, with implantation of a new sutureless, scleral fixated intraocular lens (IOL) (Carlevale, Soleko), in a case of bullous keratopathy and IOL mispositioning. Observations: Two scleral pockets were created along two scleral radial incisions, 180° apart, followed by two 23 G sclerotomies at the pockets' sites. After removal of the dislocated IOL through a corneoscleral incision, posterior vitrectomy was completed. The Carlevale IOL was injected into the anterior chamber (AC) and placed above the iris. The haptics were then externalized using opening distal forceps through the sclerotomies, and the plugs were secured in the scleral pockets. DMEK was then performed using the "C-press" technique, where corneal indentation allowed to artificially shallow the AC to ensure successful graft unrolling. Fifteen months postoperatively, the cornea was clear, the Carlevale IOL well positioned, and the patient's vision improved. Conclusions and importance: DMEK using the C-Press technique, combined with a sutureless, scleral-fixated IOL such as the Carlevale in a single procedure, may be a safe and effective option to restore vision in case of bullous keratopathy and dislocated IOL.